Cipro, Levaquin and Avelox are Chemo Drugs

When I first heard people referring to fluoroquinolone antibiotics (Cipro, Levaquin, Avelox, Floxin and a few others) as “chemotherapy drugs,” I thought that they were exaggerating or incorrect. After all, fluoroquinolones are used to treat urinary tract infections, traveler’s diarrhea, anthrax, and other bacterial infections, not cancer. But then I started to do some research into how fluoroquinolones work and I discovered that they cause mitochondrial damage, which leads to oxidative stress and cell death (1, 2), they interfere with the DNA replication process of mitochondria (3), they disrupt tubulin assembly (4) and that they are being investigated for their tumor killing abilities (5, 6). I also found that all other drugs that have the same mechanism for action as fluoroquinolones – topoisomerase interrupters (FDA warning label, 7) (topoisomerases are necessary for proper DNA replication) – are used as chemotherapy drugs – topotecan, amsacrine, etoposide, etc. Fluoroquinolones are, truly, chemotherapy drugs – they just happen to be used as popular antibiotics. They can kill cancerous tumor cells because, in addition to killing bacterial cells, they also kill eukaryotic cells (8, 9).

Use of Fluoroquinolones for Cancer Treatment is Appropriate

There are almost certainly some legitimate and reasonable uses for fluoroquinolones as chemotherapy drugs (10). As tumor killing agents, they may save lives of those with cancer. Unfortunately, they’re not as targeted as the chemotherapy drugs that are currently in use. Many chemotherapy drugs on the market specifically target quickly dividing cells – like tumor and hair cells; so they kill the cancer cells while leaving most other cells intact. Fluoroquinolones aren’t that precise. They indiscriminately kill cells throughout the body – including neurons and lymphocytes (11) (immune system cells). The mitochondrial DNA (mtDNA) replication process is disrupted by fluoroquinolones (3), and the disruption of that process leads to mitochondrial damage, oxidative stress and cell death (12). Fluoroquinolones are effective cell killers, but because they are indiscriminate cell killers, they are a step backward in chemotherapy drug technology.

Lousy Chemo Drugs? Let’s Use Them as Antibiotics for Everyone!

Because they are not particularly good chemotherapy drugs, fluoroquinolones are rarely used for the purpose of killing cancer cells. Instead, they are used as antibiotics. They are prescribed to treat sinus infections, bladder infections, strep throat, and they are even prescribed prophylactically (typically for future treatment of travelers’ diarrhea) when no infection is present. They kill bacteria, and are effective antibiotics, but they also damage mitochondria and destroy cells and therefore have many of the same side-effects as chemotherapy drugs, because, as noted above, they are chemotherapy drugs.

Side-Effects of Fluoroquinolones, and Other Chemotherapy Drugs

Some of the side-effects that fluoroquinolones share with chemotherapy drugs are (13, 14, 15, 16 and the FDA warning label for Ciprofloxacin – the warning labels for Levofloxacin and the other fluoroquinolones are similar):

When one thinks of fluoroquinolones as chemotherapy drugs as opposed to antibiotics (yes, they do kill bacteria, but they should not be thought of in the same terms as benign drugs like penicillin and cephalosporins), many aspects of adverse reactions to fluoroquinolones make sense. Like several other chemotherapy drugs, there is a tolerance threshold (and/or lifetime limit) for fluoroquinolones (20, 21). Many people don’t react to their first dose of a fluoroquinolone. Rather, they tolerate the drugs up to a point – then they can no longer tolerate them and Fluoroquinolone Toxicity results. For fluoroquinolones, and possibly for other chemotherapy drugs, this tolerance threshold issue is because mitochondria are able to withstand a certain amount of damage before a disease state ensues. It is only after the tolerance threshold for damage is crossed that mitochondria stop adapting to harmful stimuli and a disease state ensues. (22)

Cellular Damage from Chemo Drugs can Lead to Cancer – Isn’t that Ironic?

Destruction of mitochondrial DNA can result in mitochondrial dysfunction and oxidative stress – which lead to apoptosis and necrosis of cells (23). When this occurs, a multi-symptom, chronic, autoimmune-disease-like reactions can occur (24, 25). However, if cell damage occurs but the cell does not die, but rather replicates the DNA errors, cancer can result (26, 27, 12).

Additionally, drugs that inhibit CYP450 liver enzymes [Cytochrome P450 enzymes metabolize xenobiotics and foreign chemicals from the body. (28)] leave people more susceptible to cancer-causing pathogens (29). Fluoroquinolones inhibit multiple CYP450 enzymes (30, FDA warning label). How ironic, isn’t it? Cancer can result from chemotherapy drugs. And when it is understood that fluoroquinolones are chemotherapy drugs that damage mtDNA and cause oxidative stress and apoptosis/necrosis, the irony of chemotherapeutic drugs causing cancer becomes horrifying, as opposed to thought-provoking.

Cellular Harm Results from Willful Ignorance About the Effects of Fluoroquinolones

There are articles that say that fluoroquinolones have an excellent safety record. (31) None of those articles look at the effects of these drugs on the mitochondria – the depletion of mtDNA, the oxidative stress that results from damaged mitochondria, the DNA damage that is caused by the oxidative stress, etc. In not looking at mitochondria, those articles are looking at the wrong things and they in no way negate the findings of the articles that note the deleterious effects of fluoroquinolones on human cells.

While it may be appropriate to give drugs that disrupt the process of mitochondrial DNA replication, have horrific side-effects and cause indiscriminate cell death, to people who are have cancer, it is absurd to give them to people who are healthy other than a minor infection. Even for major, difficult to treat infections, fluoroquinolones should be the drugs of last resort because of their effects on mitochondria. (1, 32) Chemotherapy drugs should be used exclusively in life-or-death situations. They should not be used frivolously or without true informed consent of the patient, or without awareness of the consequences of the drug on the part of both the physician and the patient. Protocols should be in place for ensuring that they are used appropriately and that all parties are aware of the consequences of the drugs.

Sadly, appropriate informed consent around fluoroquinolones involves a complete shift in how physicians and patients alike think about them. In order for the risks of taking fluoroquinolones to be properly acknowledged, all parties involved need to see, and acknowledge, that fluoroquinolones are chemotherapeutic drugs that cause mitochondrial destruction and cell death, and that they should not be used lightly. But because fluoroquinolones have been given out frivolously – 26.9 million prescriptions for oral and IV fluoroquinolones were given out in 2011 alone (33) for simple infections, I don’t foresee the shift in how they are perceived as an easy one. It must involve many doctors admitting that they have been prescribing these drugs incorrectly for decades, that they have been wrong about the severity of adverse effects, and that they have been misled about the risks of fluoroquinolones.

The Effects of Drugs on Mitochondria are Systematically Disregarded

It should also be noted that the effects of drugs on mitochondria are systematically disregarded. Mitochondrial function, and drug-induced dysfunction, is important to all areas of human health. An article published in Molecular Nutrition and Food Research entitled “Medication Induced Mitochondrial Damage and Disease” noted that the effects of drugs on mitochondria are ignored by both the drug companies and the FDA when reviewing drug safety. Because of this omission in review and oversight, human mitochondrial DNA have been repeatedly damaged by fluoroquinolones and other pharmaceuticals. The consequences of this are, as of yet, unknown. (Though it should be noted that mitochondria and the signals that they produce influence gene expression (35) and that an article published in Nature in July, 2013 entitled “Topoisomerases Facilitate Transcription of Long Genes Linked to Autism” showed that topoisomerase interrupting chemotherapy drugs effect the expression of genes linked to Autism.) We can only hope that the FDA’s failure to force drug reviewers to look at the effects of drugs on mitochondrial DNA isn’t horribly consequential.

Information about Fluoroquinolone Toxicity

Information about the author, and adverse reactions to fluoroquinolone antibiotics (Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin and Floxin/ofloxacin) can be found on Lisa Bloomquist’s site, www.floxiehope.com.

Participate in Research

Hormones MatterTM is conducting research on the side effects and adverse events associated with the fluoroquinolone antibiotics, Cipro, Levaquin, Avelox and others: The Fluoroquinolone Antibiotics Side Effects Study. The study is anonymous, takes 20-30 minutes to complete and is open to anyone who has used a fluoroquinolone antibiotic. Please complete the study and help us understand the scope of fluoroquinolone reactions.

Hormones MatterTM conducts other crowdsourced surveys on medication reactions. To take one of our other surveys, click here.

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Lisa Bloomquist was "Floxed" on her 32nd birthday by Cipro, a fluoroquinolone antibiotic. After 2 years of battling the mysterious health ailments that come with an adverse reaction to a fluoroquinolone, she has fought her way back to health. Lisa is now fighting for recognition of the harm that these drugs can cause and hoping to help those who are suffering from them through their fluoroquinolone induced illness to find recovery. Her web site, highlighting stories of hope and recovery, is www.floxiehope.com. After a while of studying how fluoroquinolones damage mitochondria, she noted that mitochondria were being systematically ignored when forming disease models. She started www.mitomadness.com to bring attention to the role that mitochondria play in health and disease.

20 Comments

In January 2015 I was put on levaquin later finding what damage it does and could have done to our whole family. Researched what could be done and found out when you go to a hospital or drs. office write that you want to see any drugs they want give you on all documents and sign them before any type of treatments are given, if not leave and go to a wholeistic dr. There are many good ones … Also be sure you have a family member with you and knows what to do in case you are not conscious and go to a hospital…

Thank you, thank you for creating an informative forum to discuss Levaquin (fluroquinolones) adverse effects. In 2005, I went to the hospital for kidney stones and I was placed immediately on a Levaquin IV drip. I had never been sick before with anything other than a mild cold and was a runner. I was a young mother of three young kids. I had a kidney stone that would not pass.The urologist just kept giving orders for five days to continue the drip before he even came to see me and just kept saying I needed the antibiotic(POISON). On the 6th day, I had the stone removal procedure, but was severely ill with muscle spasms, SEVERE FATIGUE, and could not think or BREATHE well. I didn’t know what was happening to me, other than I felt I was dying. While on the 8th day I begged my husband and nurses to get me out of that hospital. I spent the next 7 years trying to figure out what happened to me. I went from Dr. to Dr. with muscle spasms and severe fatigue and a feeling that I couldn’t catch my breath. None of the Drs. seemed to know what to do, other than to say I might have fibromyalgia. Interesting that I was 33 years old and had never had any health problems or concerns, but only after Levaquin. In my opinion, A nightmarish drug that is poisonous. I have never been the same since and have struggled to exercise and take care of myself. I thank God today and everyday that I am sane and still alive. I wish I knew how bad the drug was because I would have never let the Dr. administer poison, especially with no infection, just a bad kidney stone. Stay strong people who have been floxed.

On Feb. 1st 2016 I was hospitalized for Colitis. For eight days they pumped Cipro through my IV and on the seventh day I started having severe muscle and joint pain. They said my potassium was low and started pumping potassium in along with the Cipro and had me drink a few cups of potassium. On the ninth day I was discharged and went home. After about a week of not being able to hardly stand or get out of bed my daughter called and had me seen by a neurologist and a rumatoligist. After the blood work came back I was told I was in the healing stages of Epstein Barr and I had Fibromyalgia. I was given the diagnosis of Fibromyalgia from the rumatoligist also. Since this time my doctor has started me on Lyricia and Duloxitine. The new meds do help but my life has changed so drastically. I spend most of my days at home in bed. The times I do get out its not for long because I wear out so quickly. I have three grandchildren that I’m missing out on so much with them.

I’m so sorry for everything you’re going through! Symptoms of fibromyalgia, chronic fatigue, dysautonomia, and more, are common post-fluoroquinolone. The FDA just recognized that the disabling adverse-effects of these drugs are severe, and hopefully that will mean that fluoroquinolone toxicity will be recognized by more doctors soon.

It’s interesting that you brought up Epstein Barr. I haven’t seen anything in the peer-reviewed journals about a connection between EBV and FQs, but there are some similarities that pique my interest. EBV seems to be triggered by heavy metals, and I wonder if it’s also triggered by fluorine. I don’t know, to tell you the truth, but I do know that Cipro is a FLUOROquinolone and that it is highly fluorinated. Fluorine in itself is more likely the culprit than the round-about potential association with EBV, but, our bodies are complicated, and the connection may exist. Anthony Williams, a “medical medium,” had an interesting podcast about EBV – http://www.healyourlife.com/the-hidden-cause-of-chronic-fatigue-syndrome. I’m not entirely sold on what he says, because he backs up most of what he says with, “spirit told me” rather than research, but I still found the linked podcast to be fascinating, and, well, maybe there’s a connection and he’s right. It’s at least worth looking into.

I also tested positive for EBV. was told i was at the end stage of mono.Was told possible fibromyalgia. I also tested positive for RA, then later was negative. I have PN now. I have seen over 20 different doctors and specialists and none of them know what is wrong with me. What can we look for in blood work? I have issues with high WBC, high immature granocylytes, high BUN, low vitamen D, Lymphocytes absolute high, and in the very beginning i had very high CRP 20.9. I dont know how to get any doctor to believe me or how to prove it. In the end i was sent to two different shrinks. I am starting to lose the ability to use my hands they are so numb and painful. At least my stomach is feeling better and i dont feel like I have the flu 24/7s. I am just wondering how doctors can tell it was from cipro. or how did you prove it. i cant get one to listen to me so i quit trying. I was dismissed by every doctor i mentioned it to. Everything started 3 days after i started cipro and i was told by ENT to keep taking cipro. so i took the entire bottle.

I’ve taken Cipro for a bladder infection and twice for sinus infections in 2008 / 2010. In 2012 I was diagnosed with Dysautonomia, autoimmune if the ovaries and intestines, and growth hormone deficiency. In April 2016 I was diagnosed with breast cancer at age 39. My genetics testing was negative. There must be a link! Thank you for sharing!

Sorry for the delayed response! I’m also sorry to hear of all the health issues you’ve had! Dysautonomia ,autoimmune problems, and hormonal problems, are common for people going through FQ toxicity. I wish that there wasn’t a cancer connection too, because it’s scary, but these drugs damage cells, and damaged cells can lead to cancer. More research needs to be done on all of these connections. I hope that more research will be done soon, because these outcomes are beyond unacceptable. Here is a page with links to a few hundred articles about fluoroquinolone toxicity – https://floxiehope.com/fluoroquinolones-links-resources/. I hope that they help!

I am a perfect example of DNA damage from drugs. Took only one station drug pill for 8 years and got life threatening cancer which was proven from the toxicity of the drug.. Had menthol phenol poisoning which is a carcinogen metabolite of most statin cholesterol pills which is made from petroleum road tar. People are getting cancer from prescription drugs more than any other source. Don,t take drugs. The medical field does nothing to help you when you are injured by them. Drugs kill.

Thank you for this article. With your explanations, I can now put my mind at ease. I was given Cipro in November, and for a little while, have had some pretty bad effects, all listed as possible effects of the usage of these meds. The building up of it in your system, and how everyone has different tolerance levels is what helped me most. I was told that even when I get better, that years later I could die from the fact that I ever took this. I am not in panic mode now, and I was since last night, awake in fear. Thank you.

I have some dogs. The first bitch suffered some malignancy and she was operated because the area around the vagina had swelled gradually. Though I avoided the surgery in the beginning, eventually she was operated and again the swelling returned. Eventually a verbal chemo drug was prescribed, but the drug immediately put her in agony and she died in a day or two. After a years time another bitch suffered the same fate but her condition deteriorated faster, she was not operated upon neither any oral chemo tablets were given, but her condition deteriorated. One night before she was put down, I gave her xynalene which kept her unconscious. This sedation lasted for two hours and I repeatedly injected the drug because she had unbearable pain. Finally in the morning she was euthanised.
Finally 3 months back the third bitch developed similar symptoms. The vet said she had tumour and in this case there was continuous bleeding
Operation was not advised. It was certainly going to end fatally. I called my friend who is a doctor and asked him if any antibiotic might help. He after a lot of thinking suggested avilox. Gradually the bleeding subsided in 3 days and after 12 days of continuous treatment avilox was stopped, the swelling also subsided a bit
But after a weeks time we again Gave her avelox for 12 days and this time also the bleeding was gone in 3 days but also the swelling furtjer subsided. Now she was without any problems for 40 days aftrr her avilox couse was completed. Then after this 40 days period as soon as sje staryed bleedin ee repeated the 22 days course. This time once again her swlling furthrr sunsided. Lets seeits nrarly 15 daya since her 12 days dose eas completed. Thank you amd i will further inform u.

I’m so sorry to hear of the health problems your dogs have experienced! I have a web site to highlight the problem of “floxed” (adverse reaction to fluoroquinolones – cipro, levaquin, avelox, floxin and their generic counterparts) pets. It’s http://www.floxiepets.com. If you would like to share your story on that site, please let me know. I hope that your dog gets through her health issues without being hurt by these drugs! Please do let me know.

Thank you very much for sharing your story! I am sorry to hear of all that you have been through and I am glad that you are doing well now!

Fluoroquinolones, including cipro, levaquin and avelox, have, without a doubt helped people to recover from serious infections and they have even saved lives. In my opinion, they should not be banned. But they should be used very cautiously and only when all other options have been exhausted because the adverse effects of them are so long-lasting and severe.

It would be nice to know what genetic (and other) factors predispose some people toward suffering from fluoroquinolone toxicity syndrome. Until precautionary tests can tell doctors and pharmacists whether or not a person will have a reaction to a fluoroquinolone that can include psychosis, seizures, peripheral neuropathy, tendon ruptures, loss of cartilage, muscle wasting, etc., I think that more caution is warranted, not less.

Since these comments are on a post about FQs being chemo drugs, I’ll continue with the analogy. Chemo drugs save lives. My Dad’s life was saved by chemo. He is doing well today. That doesn’t mean that the chemo drugs that he was given to treat lymphoma are appropriate to give to someone without lymphoma for a more minor ailment.

I truly am glad that levaquin helped you. I probably could have done without taking cipro for a urinary tract infection. Individualized medicine could have helped us both. We aren’t there yet. Maybe someday.

I have had kidney stones and chronic urinary tract and kidney infections for almost 35 years of my 39 years alive. As a child I was not diagnosed or treated at all for kidney stones and infections. Thru out my twenties living in New York city and New Jersey I suffered more than any time in my life out of the reluctance of doctors and nurses practitioners who would not give me antibiotocs and strong enough antibiotocs and long enough courses of antibiotocs. I was not immune. My whole life I eat fresh organic food and such. I listened to Doctors tell me for years that I had to let my immune system fight infections. I also have a friend who had a kidney infection for one month and nearly lost her unborn baby because of the infection- she suffered so badly her pain was torture to boot. I have seen another good friend defend into advanced pneumonia because she was not given a serious anti biotic for her initial infection. making a long story short- in my experience dr’s under prescribe appropriate antibiotocs. For every complaint about antibiotic damage u do not know how bad it may have been had powerful antibiotocs not been prescribed. One must take antibiotics along with an abundance of supplements appropriate for illness and interactions. I was saved by levaquin a few years ago as I finally was given to a nephrologist for kidney failiure (due to chronic infections). Now I am much healthier that I have been in my whole life- acute water retention, kidney pain, bloody stools, head aches, fatigue, and then near death toxemia- have all been stopped by levaquin. I know levaquins side effects but by the grace of God it is nothing compared to what I experienced for nearly my whole life. I am perplexed why I was not treated with powerful drugs many years ago. I have even wondered if the doctors I was u fortunate to see and know were sadistic in their unwillingness to treat my infections. I have been infections free and pain free for 3 years now. I would rather die and I would be dead if not for levaquin. There r a good number of people beside me who would be dead with out these drugs. its just maybe I some cases or most- u don’t know how bad it could have got.

Very informative article. I was floxed in 2001, and again in 2004. Was given steroids with the antibiotics. No one knew anything back then, and only warning was to stay out of the sun. That was the least damaging. I am disabled, my shoulders have no cartlidge left, my tendons all are damaged, and I understand now that the DNA gets changed by the Cipro and they heal damaged. My shoulders froze up in 2004, after given the Cipro and a shot of cortisone. and the treatment for that was MORE cortisone. I also was given a shot of Kenalog, with 4 shots of cortisone in my shoulders and elbows. I ended up in mental ward with steroid psychosis. Afterwards, I began having pulling and tearing in my arms and legs, cramps in feet, all the time. This went on for several years. Kept getting more shots of steroids. I didn’t realize it was actually making things worse. It caused my heart to have AFIB,and SVT. I had “flashes” in my eyes at night, and developed large floaters, so I can’t sit and read for any amount of time. My shoulders are totally shot, the joint travels up into the rotator cuff now, have constant pain all over my body. Doctors will not even talk to me about Cipro tendon damage. I even had a Reumatologist raise his voice at me and said “if you had damage, it would be healed by now – wouldn’t it!!! People need to be told what these antibiotics will do to them. I have been miserable for 10 years now, and it is just getting worse every year.

Thank you, Meghan! I love your fighting spirit! The more people who stand up to the pharmaceutical companies, the better. It is not okay for them to hurt us. It is not okay for unnecessarily strong drugs to be used when there are safer alternatives. It is not okay for there to be no recourse for those who are hurt by these drugs. So, we will scream about the wrongness of the situation until we are heard. The truth is on our side, and hundreds of peer-reviewed journal articles are also on our side. Perhaps it is naive of me, but I think that the truth will protect us.

I’ll send you an email with ideas about how we can go about making change. Thank you so much for your desire to help! We will get this done. I’m not yet sure of how or when, but it will happen.

Thank you Lisa for putting all of this together, i must print & give to my doctor and possibly my own family whom I don’t think truly believe me & that makes it more difficult. I had a really hard time with that but I do know my mom believes in me. I also have six sisters and a brother, tons of cousins, aunts and uncles and am an Aunt eleven times, I want them to understand the importance not even for me at this point but I NEVER want to see this happen to any of them or ANYONE,it’s heartbreaking. I have one sister who took Cipro last year, I couldn’t believe it, she already has MS so it really scared me more, but soon after she had a ton of dental problems and now hypothyroidism, she did say she would not take it again. You have put so much time into this as I can see and I am forever grateful as I have wanted to do the same but too I’ll, I’m also coming to the end of my disability case so I will have the medic aide & see the specialists needed, I’m almost afraid to give this to my doc because I was accepted cause I lost my business,my cognitive & memory were affected horribly amongst a host of other things & I was an analyst before & was very good at breaking complex audit rules down for my clients & submitting very detailed dispute packages together to all of the largest workers compensation insurance companies so they would have to go make and give back money to policy holders/business owners. I don’t want my doc dropping me for now until medic aide kicks in & I can have more of a choice of whom I see. After that I will have more time to go to the right docs and would love to be more of a help in the advocacy aspect of this. My old business people use to joke that I was like an Erin brockovich & wasn’t I afraid of having my Knees knocked out because of all the money, hundreds of thousands of dollars, I can no longer do that for now, but for now I have always noticed you learn a lot in hindset, it’s frustrating when my family asks when I will be doing that again, but for me I learned a lot in that corp world of the insurance companies, lawyers, the state huge rule books and many gray areas of the industry. Now I want to make this my “business” advocating, bringing awareness & working at using my skills again in compiling data to make a difference. I wasn’t afraid of the insurance companies before & their tactics & I’m certainly not afraid of the pharmaceutical or different agencies involved and as I said before I’m educated in dealing with “corporate bullies”… I have so much info on this & a lot of great ideas. Thank you again, you make a real difference!! I look so very forward to being of more assistance!

Thank you, Holland! I completely agree that denial of adverse drug reactions is a huge problem. I imagine that I will write about it at some point. I think that you could write an excellent post on the topic – if you’re interested in doing so. 🙂

Also, your point about the widespread denial is big enough to warrant an entire other post. When adverse effects happen, victims today have no recourse and no healthcare support. ER doctors, prescribing physicians and even specialists are clueless how to recognize, diagnose and/or treat the very problems the FDA warns of when they occur. Can you imagine a cancer patient reporting to his treating oncologist that he was suffering burning skin, neuropathy, or extreme nausea from the chemo only to be told “you’re imagining things”? Unthinkable. But it happens to victims of FQ toxicity every day. Yes, most victims are denied care for the very same adverse effects the FDA acknowledges. Fearing lawsuits, even compassionate doctors are reluctant to report adverse effects. Talk about adding insult to injury! I personally think the years of being told nothing is wrong, and/or the wild goose chases after phantom diseases compounds the harm really significantly. I’ve heard people say it would be easier to have cancer, because you wouldn’t be expected to prove you’re sick all the time, and there would be a treatment plan!

Brava! You’ve done an amazing job in this post. Thank you for taking a bunch of hitherto related but disconnected concepts and synthesizing into a single article that thoroughly covers much needed ground. The damage done to DNA is not widely understood. At least now we can say these drugs are chemo, and they put you through hell like chemo, and then sometimes, later, they give you cancer. You’ve made that so clear.